About NEP Dental
Northeast Pediatric Dental (NEP Dental) is a small U.S. dental practice that treats only children: every patient is under 18. Its schedule lives in Dentrix, the desktop practice management and EHR system, and its patients’ dental benefits come from several payers, including Avesis, Keystone First and UHC Community Plan.
Before every visit, the front desk and the clinical team need answers to two questions:
- Is the patient’s coverage active today?
- Which procedures will the plan pay for at this visit, and which ones not yet?
NEP Dental wanted those answers on the desk every morning, for every patient on the schedule.
Main Challenge | Frequency Limits
Confirming coverage is only the first step. Dental plans limit how often each procedure is covered, and each patient’s history decides what is allowed today. For example:
- Cleanings: once every 6 months,
- Dental X-rays: every 6 or 12 months,
- Panoramic X-rays: once every 5 years,
- Sealants: once per tooth,
- Fluoride: limited by the plan,
- X-ray allowance: limited by the remaining X-ray budget.
A procedure done before the plan allows it again is not covered, and the family may have to pay for it out of pocket.
Getting the answer by hand means the same routine for every patient, every day:
- Pull the day’s appointments from Dentrix,
- Log in to the right payer portal, including a two-factor authentication (2FA) code sent by email,
- Confirm active coverage,
- Read the patient’s procedure history and compare it with the plan’s limits,
- Write a note the front desk and clinical team can act on.
Four payer portals, each with its own login and layout, make that routine slow and easy to get wrong. At NEP Dental, these manual checks could take the front desk two to three hours a day.
A Careful Start, Not a Fast One
Before quoting, we spent time mapping NEP Dental’s eligibility process step by step. That let us price and scope the project precisely, and the delivery landed almost to the day of the plan.
We started by running a proof of concept before building this automation.
The investment was still a real decision for the practice. Leonard was skeptical about the cost, and the return on investment was not going to come quickly. What decided it was the overall value of automating the process.
Solution | Dental Eligibility Automation
We built a bot that runs the whole check overnight, from the Dentrix schedule to a finished document in each patient’s chart.
How One Patient Moves Through the Bot
NEP Dental- Patient YSealantsNot eligible
- Patient ZCrownEligible
- Patient URoot canalEligible
- Patient VExtractionEligible
- Patient WFillingNot eligible
- Patient XCleaning + X-raysEligible
- Patient YSealantsNot eligible
- Patient ZCrownEligible
- Patient URoot canalEligible
- Patient VExtractionEligible
- Patient WFillingNot eligible
- 1Desktop EHR
- Patient details
- Insurance ID
- Payer
- 2Payer portal
Checking…EligibleEligibleNot eligibleEligibleNot eligibleEligible- Coverage active
- Procedure history
- Frequency limits
- Coverage active
- Procedure history
- Frequency limits
- Coverage active
- Procedure history
- Frequency limits
- 3PDFPDFPDFPDFPDFPDFPDFU-summary.pdfV-summary.pdfW-summary.pdfX-summary.pdfY-summary.pdfZ-summary.pdfEligibleEligibleNot eligibleEligibleNot eligibleEligible
Scope: Three Payers, About 80% of Cases
We did not try to automate every payer at once. We started with the three payers behind most visits: Avesis, Keystone First and UHC Community Plan. Together they account for about 80% of NEP Dental’s eligibility checks. The remaining payers bring only occasional patients, so they were left out of the first scope.
The build took about a month, a typical timeline for a project like this. The number of payer portals was the main factor.
Connecting to desktop Dentrix was not the hardest part. The real work was turning the practice’s knowledge of its payers’ rules into automation.
How the Eligibility Check Works
- Scheduled start: The bot starts every workday at 3:00 AM, in the practice’s time zone, and finishes in about an hour.
- Appointment list: It logs in to Dentrix and pulls the day’s appointments: patient details, insurance ID number, appointment time and type, and payer.
- Payer portal login: For each patient, it logs in to that payer’s portal and passes 2FA automatically, reading the code from Outlook.
- Coverage and history: It confirms the patient has active coverage and downloads the history of completed procedures.
- Frequency rules: It compares the procedure codes in that history with the plan’s limits and works out what can and cannot be done at this visit.
- Documents: It creates a PDF for every patient, uploads it to the patient’s chart in Dentrix, and builds a print packet and a daily Excel report.
The bot reports what the plan covers. The dentist still decides the treatment.
What the Bot Checks
| Procedure | Plan limit the bot checks |
|---|---|
| Cleaning | Once every 6 months |
| Dental X-rays | Every 6 or 12 months |
| Panoramic X-ray | Once every 5 years |
| Sealants | Once per tooth |
| Fluoride | The plan’s fluoride limit |
| X-ray allowance | Remaining X-ray budget |
Systems and Payer Portals
| System | Role |
|---|---|
| Dentrix (desktop) | Source of the day’s appointments; destination for patient PDFs |
| PA PROMISe Portal and Avesis Provider Portal | Payer: Avesis |
| DentaQuest Portal | Payer: Keystone First |
| UnitedHealthcare Dental Hub (Skygen) | Payer: UHC Community Plan |
| Outlook | 2FA codes from email |
| Excel | Daily summary report |
Results
When the front desk arrives, the checks are already done. Each morning, the team has:
- A PDF in every patient’s Dentrix chart: a summary for the front desk and the clinical team, the procedure history and screenshots from the payer portal,
- One combined PDF to print, sorted by appointment time,
- A daily Excel report on the practice’s server.
Every summary lands in the patient’s chart and on the front desk, so everything is ready before the first patient walks in.
About an hour of bot time now replaces two to three hours of manual checks at the front desk. That time goes back to patients and their families instead of paperwork, which can also improve patient satisfaction (NPS).
Checking coverage and frequency limits before the visit also lowers the risk of billing problems. The team knows in advance which services the plan will cover, so families are not surprised by a bill for a procedure the plan did not pay for.
No Yearly License
The bot is written in Python, so there is no software license to renew. NEP Dental pays for a one-time build plus ongoing maintenance, instead of a yearly fee. A UiPath license starts at about $15,000 a year.
Full flexibility of the project and zero license costs. These were the main advantages of using Python instead of UiPath for this project. This choice reduced potential costs by nearly $15,000.
Summary
NEP Dental’s eligibility checks now run overnight, in four payer portals, with 2FA handled automatically. Each morning starts with coverage confirmed, frequency limits checked and a document in every patient’s chart, with no yearly license fee. The first scope covers the three payers behind about 80% of cases.
| Metric | Result |
|---|---|
| Checks ready | Before the first patient: the bot starts at 3:00 AM every workday |
| Payer portals | 4, with 2FA handled automatically |
| Front desk time | 2–3 hours of manual checks a day → about 1 hour of bot time |
| Payer coverage | 3 payers, about 80% of cases |
| Implementation | About 1 month |
| Yearly license cost | $0 (UiPath licenses start at about $15,000 a year) |
